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Research article
Zhijie Wang
The Affiliated Hospital of Qingdao University
Corresponding Author
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Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury.
Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software.
Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline.
Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.
Keywords
Pedicle screw insertion, Bicortical anchorage, Thoracic and lumbar spine disease, aorta, Inferior vena cava, Prone CT three-dimensional reconstruction
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CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 27 Apr, 2020
No community comments so far
Editorial decision: Major revision
On 17 Jun, 2020
Review #2 received
Received 22 May, 2020
Review #1 received
Received 15 May, 2020
Reviewer #2 agreed
On 05 May, 2020
Reviewers invited
Invitations sent on 30 Apr, 2020
Reviewer #1 agreed
On 30 Apr, 2020
Editor assigned
On 21 Apr, 2020
Editor invited
On 20 Apr, 2020
Submission checks complete
On 19 Apr, 2020
No comments provided
Editorial decision: Major revision
On 23 Mar, 2020
Review #3 received
Received 20 Mar, 2020
Review #4 received
Received 17 Mar, 2020
Review #2 received
Received 15 Mar, 2020
Reviewer #4 agreed
On 07 Mar, 2020
Reviewer #2 agreed
On 06 Mar, 2020
Reviewer #3 agreed
On 06 Mar, 2020
Review #1 received
Received 03 Feb, 2020
Reviewers invited
Invitations sent on 21 Jan, 2020
Reviewer #1 agreed
On 21 Jan, 2020
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 24 Dec, 2019
Editor invited
On 24 Dec, 2019
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Zhijie Wang
The Affiliated Hospital of Qingdao University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 27 Apr, 2020
No community comments so far
Editorial decision: Major revision
On 17 Jun, 2020
Review #2 received
Received 22 May, 2020
Review #1 received
Received 15 May, 2020
Reviewer #2 agreed
On 05 May, 2020
Reviewers invited
Invitations sent on 30 Apr, 2020
Reviewer #1 agreed
On 30 Apr, 2020
Editor assigned
On 21 Apr, 2020
Editor invited
On 20 Apr, 2020
Submission checks complete
On 19 Apr, 2020
No comments provided
Editorial decision: Major revision
On 23 Mar, 2020
Review #3 received
Received 20 Mar, 2020
Review #4 received
Received 17 Mar, 2020
Review #2 received
Received 15 Mar, 2020
Reviewer #4 agreed
On 07 Mar, 2020
Reviewer #2 agreed
On 06 Mar, 2020
Reviewer #3 agreed
On 06 Mar, 2020
Review #1 received
Received 03 Feb, 2020
Reviewers invited
Invitations sent on 21 Jan, 2020
Reviewer #1 agreed
On 21 Jan, 2020
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 24 Dec, 2019
Editor invited
On 24 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury.
Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software.
Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline.
Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
This is a list of supplementary files associated with this preprint. Click to download.
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